Significance of Inducible Very Fast Ventricular Tachycardia (Cycle Length 200–230 ms) After Early Reperfusion for ST-Segment–Elevation Myocardial Infarction

Zaman, Sarah; Kumar, Saurabh; Sullivan, Janice; Narayan, Arun; Thiagalingam, Aravinda; Ross, David L.; Kovoor, Pramesh

doi:10.1161/circep.113.000213

Cited by 19 publications

(23 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, this fast inducible VT has been found to be of the same prognostic significance as a VT cycle length >230 milliseconds and makes up the majority of inducible VT in contemporary post-MI patients who have been reperfused early with PCI. 76,80 A PVS protocol containing 4 extrastimuli, with the inclusion of inducible monomorphic VT cycle length >200 milliseconds (but not VF) as a positive result, was found to best identify patients at high risk of tachyarrhythmia (Figure 2). 74,[80][81][82][83] A negative result obtained with such a PVS protocol implies a low rate of death or arrhythmia, even in the presence of severe LV dysfunction (LVEF ≤35%).…”

Section: Cmrmentioning

confidence: 99%

“…76,80 A PVS protocol containing 4 extrastimuli, with the inclusion of inducible monomorphic VT cycle length >200 milliseconds (but not VF) as a positive result, was found to best identify patients at high risk of tachyarrhythmia (Figure 2). 74,[80][81][82][83] A negative result obtained with such a PVS protocol implies a low rate of death or arrhythmia, even in the presence of severe LV dysfunction (LVEF ≤35%). 84 In addition, using this PVS protocol to select patients for an early ICD identified those patients who survived long term after ICD treatment for arrhythmia.…”

Section: Cmrmentioning

confidence: 99%

“…74,[80][81][82][83] A negative result obtained with such a PVS protocol implies a low rate of death or arrhythmia, even in the presence of severe LV dysfunction (LVEF ≤35%).…”

mentioning

confidence: 99%

“…80 Although EPS is an invasive test with the potential risk of infection, bleeding, and, rarely, pericardial tamponade, it has been shown to be safe even in the acute post-MI period in the presence of dual antiplatelets.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Sudden Cardiac Death Early After Myocardial Infarction

2014

Self Cite

View full text Add to dashboard Cite

The issue of SCD primary prevention early after MI remains unresolved. The focus is now firmly centered on the elucidation of risk stratification tests that effectively select patients at high risk of SCD who benefit from early ICD implantation. Zaman and Kovoor Primary Prevention of SCD Early After MI 2429A summary of major risk stratification tests currently used to identify patients at high risk of SCD is given in Table 2. LV DysfunctionImpaired LVEF, one of the most powerful predictors of survival, 64 has been shown to identify patients who derive a mortality benefit from an ICD when implanted predominantly in the remote period after MI. 16,65 However, there are major concerns with the use of LVEF alone as a risk stratifier to guide ICD implantation. One such concern is the low specificity of LVEF for selecting patients who experience arrhythmic versus nonarrhythmic death. In the MADIT II trial, the use of LVEF ≤30% alone to stratify patients for an ICD resulted in relatively small absolute improvement in mortality with low therapeutic efficiency (15-17 defibrillators per life saved). 66 Another concern is the sensitivity of LVEF, given that a large proportion of SCDs still occur in patients with preserved LV function. VALIANT demonstrated that, although the risk of SCD is greatest in patients with severe dysfunction (LVEF ≤30%), almost half of all sudden deaths occur in patients with a higher ejection fraction (LVEF, 31%-40%). 5 The use of LVEF as a risk stratification tool has been tested in the early post-MI stage in the DINAMIT and IRIS trials, which selected patients with LVEF ≤35% and ≤40%, respectively, and failed to show a benefit of early ICD implantation. 12,17 The major limitation with the use of an early LVEF cutoff is the phenomenon of myocardial stunning with variable and unpredictable recovery of LV function after MI. This is especially relevant in the contemporary era of primary PCI for STEMI. Of STEMI patients with LVEF ≤40% at day 3, 24% will improve to have an LVEF >40% at 6 months with a mean 6% relative improvement. 67 Hence, although LV function will invariably be incorporated into risk stratification models for the prevention of SCD, it is clear that other tests are required to adequately select high-risk patients early after MI. RV DysfunctionAlthough impaired LV function has been studied extensively as a predictor of mortality and arrhythmic death, RV dysfunction has been largely overlooked. We know from the VALIANT study that almost 50% of arrhythmic deaths occur in patients with a preserved LVEF.5 RV involvement in inferior MI has been shown to be a predictor of morbidity and mortality, with a higher rate of serious arrhythmias in patients with inferior MI and RV dysfunction. 68,69 In addition, RV dysfunction has been correlated with increased inducibility of VT at EPS. 70 Although there is no current evidence to support the role of early RV assessment to guide ICD implantation, these findings highlight the inadequacy of LVEF alone as a risk stratification tool for the prevention...

show abstract

Section: Cmrmentioning

confidence: 99%

Section: Cmrmentioning

confidence: 99%

“…74,[80][81][82][83] A negative result obtained with such a PVS protocol implies a low rate of death or arrhythmia, even in the presence of severe LV dysfunction (LVEF ≤35%).…”

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Sudden Cardiac Death Early After Myocardial Infarction

2014

Self Cite

View full text Add to dashboard Cite

show abstract

“…Thus, we lack updated data regarding the outcome of non-inducible patients who were treated based on current guidelines and recommendations, including the use of β-blockers. Recently, Zaman et al showed that PES is a strong predictor of mortality early after acute MI [13]. Current guidelines recommend ICD for patients with EF r35% and New York Heart Association (NYHA) class II or III status, without the need to induce VT during PES.…”

Section: Discussionmentioning

confidence: 99%

Programmed electrical stimulation for risk stratification of patients with ischemic cardiomyopathy

Danon

Schliamser

Lavi

et al. 2014

Journal of Arrhythmia

View full text Add to dashboard Cite

a b s t r a c tBackground: Patients with ischemic cardiomyopathy (ICM) are at an increased risk for sudden death. Although earlier trials used programmed electrical stimulation (PES) for risk stratification, more recent data demonstrate the benefit of implantable cardiac defibrillators (ICDs) in selected patients with reduced left ventricular ejection fraction (LVEF) without performing PES. However, little is known about the outcome of non-inducible patients. The purpose of this study was to evaluate the efficacy of PES for mortality risk stratification in patients with ICM. Methods: All consecutive patients who met the inclusion criteria (history of coronary artery disease, LVEF r 35%, and absence of documented spontaneous sustained ventricular tachycardia or aborted sudden cardiac death) were included in the study. The stimulation protocol involved up to three extrastimuli from two different sites in the right ventricle, with 180 ms as the shortest coupling interval. The primary endpoint was overall survival. Results: A total of 198 patients were included in the study; of these, 60 exhibited negative (À )PES, and 138 had positive (þ)PES and also underwent ICD implantation. The mean follow-up duration was 4.5 years. There was no difference in age or LVEF between the patient groups. We found a trend towards an increased 5-year survival rate in the (þ)PES group in whom ICD implantation had been performed (p¼ 0.058). Survival was significantly better in patients under 68 year olds in the (þ)PES group in whom ICD implantation was performed (hazard ratio¼ 0.3, p¼ 0.01). The survival rate of patients Z68 years old was similar in both groups (p¼0.95). Conclusions: Non-inducibility during PES does not predict the prognosis of patients with ischemic cardiomyopathy.

show abstract